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Self Declaration

This document is a self-declaration for the issuance of a Resident/Caste/Income/OBC/SEBC certificate in Odisha. The applicant provides personal details, family background, caste information, and income sources, affirming the accuracy of the information provided. The declaration includes a warning about the consequences of providing false information, including potential legal action and cancellation of benefits.

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manikeswarbehera973
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40 views1 page

Self Declaration

This document is a self-declaration for the issuance of a Resident/Caste/Income/OBC/SEBC certificate in Odisha. The applicant provides personal details, family background, caste information, and income sources, affirming the accuracy of the information provided. The declaration includes a warning about the consequences of providing false information, including potential legal action and cancellation of benefits.

Uploaded by

manikeswarbehera973
Copyright
© All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd

SELF DECLARATION FOR ISSUE

RESIDENT/CAST/INCOME/OBC/SEBC CERTIFICATE
(As per latter no RDM-GOEB-MLSS-0043-2014-28781 DT-27-09-2014 OF Addltlonaí Chlef secretary, Govt. of Oodisha)

[Link] .aged about


..years, s/o, D/O,

w/..[Link]. . o fV l l a i g e . B h a s k i A t a . .

PS. Bhatnipah DIST-kalakrnoi, oDISHA do hereby declare and state as follows.


1). That my father frendtather [Link]..Bkbet.a..s/. our cast is
is/was R.T/CO R.T of village
Paananandput..nder khata [Link]
their title
recorded
asket...ut subsequently Our forefather change

[Link]...2eheza..although we use the same caste.


under Scheduled
2). That, our cast is..LC..and family surname is [Link]..which comes
Ase$asper ORISSA CASTE CERTIFICATE RULE,1980,8(1.
ROR/Noter ID card
3).That, [Link]äime has been mentioned in
as....[Link] of [Link] both are one and same person
[Link]
agriculture is Rs...... and from
4]. That, our family annual income from allsources is [Link]. from
BuissnAS. source is Rs [Link]..
Which comes OBC/SEBC vide [Link] of
S)That, our cast is. but surname is

Central/state list.

Resident/Caste/Income/OBC/SEBC
61. That, ihere with furnish my self-declaration in support of my claim for issue of
certificate favor [Link] .For the purpose

[Link].
do hereby that the above Information given by me ln this application from and Its self attested encdosures is
fact That.
Ne to the best of my knowledge and that information finished is exhaustive and I have not suppressed any
responsible for the accuracy of the
dedaratlon and Information furnished and llable for action under section
am solely declaration and Information Also, Iam well aware of the fact that
penal code in case of wrong
199 and 200 of the Indian
sha! be summarily cancelled and all the
benefits avalled by me shall be summarily withdrawn in case of
the certificate
and information.
wrong decdaration

Date:

Place: hiwanipatna
Gadaoha Bees
Slgnature of the Applcant

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